目的：研究急性呼吸窘迫综合征(ARDS)患者呼出气冷凝液(EBC)和血清中一氧化氮(NO)、内皮素-1(ET-1)和8-异前列腺素(8-isoPG)的浓度变化及其临床意义。方法选取2012年9月至2014年7月在南通大学第二附属医院重症监护病房(ICU)中行机械通气的ARDS 52例患者为观察组，收集患者入院第1天及治疗后第7天呼出气冷凝液及血清标本。健康对照组为30例健康体检者，收集其EBC及血清标本。采用酶联免疫吸附法(ELISA)测定两组受检者EBC和血清中的NO、ET-1和8-isoPG浓度。结果观察组患者EBC中NO、ET-1和8-isoPG水平高于对照组[(7.33±2.21)μmol/L vs (2.37±0.79)μmol/L、(46.02±10.39)μmol/L vs (10.08±4.27)μmol/L、(55.87±13.78) pg/mL vs (21.86±9.24) pg/mL，P<0.05]；血清中NO、ET-1和8-isoPG水平高于对照组[(122.82±64.88)μmol/L vs (22.42±6.56)μmol/L、(178.82±55.21)μmol/L vs (97.32±39.74)μmol/L、(241.94±43.98) pg/mL vs (122.09±36.62) pg/mL，P<0.05]；治疗后观察组患者EBC中NO、ET-1和8-isoPG水平均较治疗前下降[(6.32±1.61)μmol/L vs (7.33±2.21)μmol/L、(32.49±10.55)μmol/L vs (46.02±10.39)μmol/L、(36.74±11.41) pg/mL vs (55.87±13.78) pg/mL，P<0.05]；血清中ET-1和8-isoPG水平低于治疗前[(158.31±55.79)μmol/L vs (178.82±55.21)μmol/L、(170.20±53.37) pg/mL vs (241.94±43.98) pg/mL，P<0.05]。结论 EBC和血清中NO、ET-1和8-isoPG浓度变化可反映ARDS患者肺部炎症反应及肺损伤严重程度；EBC反映炎症反应较血清更灵敏。%Objective To study the changes of concentration of nitric oxide (NO), endothelin-1 (ET-1) and 8-isoprostane (8-isoPG) in the exhaled breath condensate (EBC) and serum of the patients with acute respiratory dis-tress syndrome (ARDS), and investigate its clinical significance. Methods A total of 52 patients with ARDS, who admitted to Department of Emergency of the Second Affiliated Hospital of Nantong University and underwent me-chanical ventilation from September 2012 to July 2014, were recruited as the observation group. EBC and serum sam-ples of the observation group were collected on the first day and the seventh day after treatment. Meanwhile, 30 healthy subjects were selected as the control group, EBC and serum samples were collected. The concentrations of NO, ET-1 and 8-isoPG in EBC and serum of the two groups were measured by enzyme-linked immunosorbent assay (ELISA). Results The levels of NO, ET-1 and 8-isoPG in EBC of the observation group were (7.33 ± 2.21)μmol/L, (46.02±10.39)μmol/L and (55.87±13.78) pg/mL, respectively, which were significantly higher than corresponding (2.37± 0.79)μmol/L, (10.08±4.27)μmol/L and (21.86±9.24) pg/mL in EBC of the control group (P<0.05). The levels of NO, ET-1 and 8-isoPG in serum samples of the observation group were (122.82 ± 64.88)μmol/L, (178.82 ± 55.21)μmol/L and (241.94 ± 43.98) pg/mL, respectively, which were significantly higher than corresponding (22.42 ± 6.56) μmol/L, (97.32 ± 39.74)μmol/L and (122.09 ± 36.62) pg/mL in serum samples of the control group (P<0.05). After treatment, the levels of NO,ET-1 and 8-isoPG in EBC of the observation were (6.32±1.61)μmol/L, (32.49±10.55)μmol/L and (36.74± 11.41) pg/mL, respectively, which were significantly lower than corresponding (7.33±2.21)μmol/L, (46.02±10.39)μmol/L and (55.87 ± 13.78) pg/mL before treatment (P<0.05); the levels of ET-1 and 8-isoPG in serum samples were (158.31 ± 55.79) μmol/L and (170.20 ± 53.37) pg/mL, which were significantly lower than corresponding (178.82 ± 55.21) μmol/L and (241.94 ± 43.98) pg/mL before treatment (P<0.05). Conclusion The changes of concentration of NO, ET-1 and 8-isoPG in the exhaled breath condensate (EBC) and serum of the patients with ARDS can reflect the se-verity of inflammation and lung injury, and the changes in EBC concentration are more sensitive than those in serum for reflecting the inflammatory reaction.
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